changing lives in our lifetime - save the children · 9 10 factors driving change ... successfully...

CHANGING LIVESIN OUR LIFETIME

G L O B A L C H I L D H O O D R E P O R T 2 0 1 9

S U M M A R Y

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Photo: Victoria Zegler / Save the Children

CONTENTS

Some names of parents and children have been changed to protect identities.

1 Introduction

4 End of Childhood Index Results 2000 vs. 2019

9 10 Factors Driving Change for Children Since 2000

13 Recommendations

19 Progress Rankings 2000-2019

21 End of Childhood Index Rankings 2019

22 Complete End of Childhood Index 2019

26 Endnotes

28 Acknowledgements

now than there were in 2000, an 80 percent increase. Finding ways to fulfill children’s health, education and protection rights in conflict zones is central to the challenge of ensuring every child has the childhood they deserve.

WHAT DRIVES PROGRESS?In the 1990s, Save the Children pioneered a radical approach to making change that came to be known as “positive deviance.” The approach was based on the idea that within every community, there are some people who, with the same resources and constraints as everyone else, do things differently and achieve better results than the norm. Their children are healthier, better educated or better protected than one would expect, given the

In commemoration of its founding 100 years ago, Save the Children is releasing its third annual Global Childhood Report to celebrate progress for children. We examine the major reasons why childhood comes to an early end, and find significantly fewer children suffering ill-health, malnutrition, exclusion from education, child labor, child marriage, early pregnancy and violent death. In the year 2000, an estimated 970 million children were robbed of their childhoods due to these causes. That number today has been reduced to 690 million2 – meaning at least 280 million children are better off today than they would have been two decades ago.

A comparison of End of Childhood Index scores finds the overall situation for children has improved in 173 out of 176 countries since 2000. This is welcome news – and it shows that investments and policies are working to lift up many of our children. Tremendous progress for children is taking place in some of the poorest countries in the world, providing ever-increasing evidence that development work is paying huge dividends in countries where needs are greatest.

Drilling down to look at the individual indicators in the index, we find countries have made impressive progress in fulfilling children’s rights by reducing under-5 mortality. Countries have also made substantial progress in enrolling children in school and reducing malnutrition, child labor and child marriage. Progress in these areas has resulted in millions fewer children missing out on childhood. However, the world has made less progress in reducing adolescent births and child homicide, and there has been no progress at all in reducing the number of children living in areas of violence and conflict. In fact, the number of children living in war zones or forced to flee their homes due to conflict has skyrocketed since 2000.

Today, 1 child in 4 is being denied the right to a childhood – a time of life that should be safe for growing, learning and playing. These stolen childhoods are increasingly concentrated in the world’s conflict zones. As noted above, of the eight indicators we examine, displacement due to conflict is the only one that is on the rise. There are 30.5 million more forcibly displaced people

IntroductionChildren born today have a better chance than at any time in history to

grow up healthy, educated and protected, with the opportunity to reach

their full potential. Even a generation ago, a child was twice as likely to die

before reaching age 5, 70 percent more likely to be involved in child labor

and 20 percent more likely to be murdered.1

GLOBAL CHILDHOOD REPORT 1

HUNDREDS OF MILLIONS OF CHILDREN HAVE BEEN SAVEDGlobal progress has saved millions of childhoods since the year 2000. Now1 there are:

• 4.4 million fewer child deaths per year

• 49 million fewer stunted children

• 115 million fewer children out of school

• 94 million fewer child laborers

• 11 million fewer married girls

• 3 million fewer teen births per year

• 12,000 fewer child homicides per year

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challenges they face. Learning from these success stories proved to be a powerful tool to improve the well-being of children and communities, and also the effectiveness of organizations. In our centennial year, we are paying tribute to this innovative idea, and using it to identify countries that are achieving better than average progress for children. By looking at the strategies employed successfully within these countries, we find inspiration to inform work elsewhere.

Even in the poorest countries in the world, there are many examples of extraordinary progress. This is a clear demonstration that, when the right steps are taken, “development works.” Building on this evidence, this report makes a powerful case for greater investment in child-sensitive development.

Success stories in this report illustrate some of the strategies that are working to save children around the world. They include: strengthening legal frameworks, improving health systems, investing in education, improving household incomes, and empowering teenagers to make life choices that set them on a path to realize their full potential.

SUCCESS STORIESThis report includes case studies of countries that have made strong progress in improving children’s well-being in recent decades. For example:

Bangladesh has achieved remarkable reductions in under-5 mortality following sustained investments in health.

Ethiopia has dramatically lowered the prevalence of stunting through a package of interventions to improve children’s nutrition.

Mexico has greatly reduced the proportion of children involved in child labor by investing in education and poverty reduction.

Philippines achieved an impressive rise in the number of children enrolled in school by offering incentives and flexible options.

India has greatly reduced child marriage through legal reforms, programs to educate and empower girls, and public awareness campaigns.

Afghanistan has slashed its adolescent birth rate by increasing girls’ education and improving health services, with donor assistance.

Colombia is making good gains to reduce violence against children through public investments in safety and programs for at-risk youth.

Photo: Veejay Villafranca / Save the Children

The moral case for investing in children is compelling. In a world so rich in resources, know-how and technology, it is unacceptable that we allow today’s levels of child deprivation to continue.

Lost childhoods are a result of choices that exclude particular groups of children by design or neglect. A child’s experience of childhood is largely determined by the care and protection they receive, or fail to receive, from adults. The Convention on the Rights of the Child affirms children’s right to survival, food and nutrition, health and shelter. Children also have the right to be educated, both formally and informally. They have the right to live free from fear and discrimination, safe from violence, and protected from abuse and exploitation. And they have a right to be heard and to participate in decisions that affect them.3

In 2015, world leaders gathered at the United Nations to make a bold commitment – to end poverty in all its forms by 2030 and protect the planet for future generations. Taken together, the Sustainable Development Goals (SDGs) they established paint a vision of a future in which all children enjoy their rights to health, education and protection – the building blocks of childhood.4


WHAT HAS CHANGED IN 100 YEARS?Millions of children are alive and thriving today because of medical and technological advances we tend to take for granted. Breakthrough discoveries of vaccines to prevent childhood diseases, coupled with better care for mothers and babies, have saved countless lives and improved overall health. The world has also made good progress in building human and institutional capacity to deliver lifesaving solutions to the hardest to reach and most vulnerable children.

But perhaps the most important change in the last 100 years is in how we think about children. In 1919, when Eglantyne Jebb founded Save the Children, her conviction that children have a right to food, health care, education and protection from exploitation was not a mainstream idea. The Declaration on the Rights of the Child, drafted by Jebb, was adopted by the League of Nations in 1924. It asserted these rights for all children and made it the duty of the international community to put children’s rights in the forefront of planning. The Convention on the Rights of the Child, which was adopted in 1989 and has been ratified by all but one country, further changed the way children are viewed and treated – as human beings with a distinct set of rights, instead of as passive objects of care and charity.

As these visionary frameworks have gained acceptance, public opinion about children has been slowly but steadily shifting worldwide. For example, more people around the world now believe children belong in school, not toiling in fields and factories. And more governments have enacted laws to prevent child labor and child marriage, and to make school free and mandatory for all children, regardless of their gender, race, refugee status or special needs.

The world has come a long way in 100 years, but we still have a long way to go to ensure every child, everywhere, grows up healthy, educated and protected from harm.

In the 1920s in Hungary, these children and their six siblings had lost their mother and were suffering from rickets.

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Crucially, signatories to the agreement promised to ensure this would happen for all segments of society – regardless of income, geography, gender or identity. And they promised that those who are furthest behind – the most excluded in society – would be reached first.

This pledge to leave no one behind must be upheld. Only then will we realize its potential to transform the lives of millions of children across the world, guaranteeing every last child the childhood they deserve.

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the world, children are robbed of significant portions of their childhoods.

The United States, China and Russia may be the three most powerful countries in the world – in terms of their economic, military and technological strength and global

The 10 bottom-ranked countries – eight from West and Central Africa – are a reverse image of the top, performing poorly on most indicators. Children in these countries are the least likely to fully experience childhood, a time that should be dedicated to emotional, social and physical development, as well as play. Low index rankings also highlight the challenges of armed conflict and poverty. Nine of the bottom 10 countries are low-income and six of the bottom 10 are fragile and conflict-affected states.5 In these and many other countries around

End of Childhood Index Results 2000 vs. 2019Save the Children’s third annual End of Childhood Index compares the latest data

for 176 countries – more than any other year – and assesses where the most

and fewest children are missing out on childhood. Singapore tops the ranking

with a score of 989. Eight Western European countries and South Korea also

rank in the top 10, attaining very high scores for children’s health, education

and protection status. Central African Republic ranks last among countries

surveyed, scoring 394.

WHAT DO THE SCORES MEAN?End of Childhood Index scores for countries are calculated on a scale of 1 to 1,000. The scores measure the extent to which children in each country experience “childhood enders” such as death, severe malnutrition, being out of school and shouldering the burdens of adult roles in work, marriage and motherhood. Here’s a quick guide on how to interpret country scores:

940 or above – Few children missing out on childhood760 to 939 – Some children missing out on childhood600 to 759 – Many children missing out on childhood380 to 599 – Most children missing out on childhood379 or below – Nearly all children missing out on childhood

For more details, see the Methodology and Research Notes beginning on page 54 of the full report.

2019 END OF CHILDHOOD INDEX RANKINGS

RANK COUNTRY RANK COUNTRY

1 Singapore 167 Burkina Faso

2 Sweden 168 DR Congo

3 Finland 169 Guinea

3 Norway 170 Nigeria

3 Slovenia 171 Somalia

6 Germany 172 South Sudan

6 Ireland 173 Mali

8 Italy 174 Chad

8 South Korea 175 Niger

10 Belgium 176 Central African Republic

BOTTOM 10Where childhood is most threatened

TOP 10Where childhood is most protected

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Sierra Leone has achieved a 246-point increase in its index score since 2000, rising from 345 to 591. Two decades after the end of the 11-year civil war, and just a few years after a devastating Ebola outbreak, the country has made strong gains for children on almost all indicators. Child marriage is down nearly 60 percent. Under-5 mortality has been cut by more than half (53 percent). Child labor is down by at least 40 percent. Fewer children are stunted and there are fewer teen births (rates for both are down by about 30 percent). Child homicide declined 20 percent. But, by far, the greatest progress is that fewer families are affected by conflict. In 2000, 1 in every 5 people in Sierra Leone had been forcibly displaced from home. Today, that figure is 1 in 700 – a 99 percent reduction.

Rwanda’s score rose 241 points, from 503 to 744. Twenty-five years after the Rwandan genocide, the country has improved on most indicators. Under-5 mortality is down 79 percent. Many more children are in school and many fewer children are married before age 18 (the out-of-school rate and child marriage rate are both

influence – but all three badly trail most of Western Europe in helping children reach their full potential. China and the U.S. are tied for 36th place, and Russia ranks 38th. Their scores are 941, 941 and 940, respectively – at least 30 points behind most Western European countries. China has made the most progress of the three in recent decades, steadily improving conditions for its children, while Russia and the U.S. have made less progress.

GREAT GLOBAL PROGRESS FOR CHILDREN Save the Children took a look back at the data for the year 2000 and found a remarkable story of progress, in almost every country, in just one generation. A comparison of End of Childhood Index scores for 2000 and 2019 shows 173 out of 176 countries are doing better at giving their children full and stable childhoods. The most dramatic progress has been among some of the world’s poorest countries. These successes show that poverty does not have to be a barrier to progress, and political choices can matter more than national wealth.

END OF CHILDHOOD INDEX SCORES ARE BETTER NOW IN ALL REGIONS1,000

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East Asia and Pacific

Middle East and North Africa

Latin America and Caribbean

South Asia

Eastern and Southern Africa

West and Central Africa

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bottom, as the situation for children has continued to improve, while conditions have worsened in Central African Republic. Niger’s under-5 mortality rate is down 62 percent since 2000 – that’s 44,000 fewer child deaths each year. School enrollment rates have more than doubled (from 19 to 48 percent). And child homicide is down 36 percent. In 2000, nearly all children in Niger were missing out on childhood. One child in 4 did not survive to age 5. Over 80 percent of children were out of school and over half were chronically malnourished. Two-thirds of girls aged 15 to 19 were already married and more than 1 in 5 gave birth each year. Niger still has a long way to go – especially with regard to child marriage and early childbearing – but sustained improvements over the years

down by 60 percent). Rwanda has also cut child labor, adolescent births and child homicides in half since 2000.

Ethiopia increased its score by 237 points, rising from 414 to 651. Improvements in child survival and education have been the main drivers of progress, but reductions in malnutrition and child marriage have also been important. Child mortality, children out of school and child marriage have all been cut by about half or more. The adolescent birth rate is down 41 percent, stunting is down 33 percent, and child homicide is down 30 percent.

Niger has more than doubled its score since 2000, from 167 to 402. In relative terms, this is the greatest increase of any country. Niger was the lowest-ranked country on the index in 2017 and 2018, but this year it rises from the

“ I feel like I own the world.... Gaining literacy and numeracy skills, and creating my own business, is the gateway to controlling my own life.” – Sabreen, age 15


rising from 617 to 811, mostly by getting more children into school. Afghanistan also made excellent progress, increasing its score 185 points, from 411 to 596, by cutting child deaths and teen births in half. Bangladesh’s score rose 153 points, from 575 to 728, primarily because of improvements in child survival. Nepal’s score is up 142 points, from 543 to 685, due mostly to decreases in mortality, malnutrition and teen births. And India’s score is up 137 points, from 632 to 769, largely because of improvements in child health and survival.

In East Asia and the Pacific, Timor-Leste raised its score 199 points, from 526 to 725, mostly due to reductions in child deaths and displacement. The score for Cambodia increased 149 points, from 606 to 755, because of gains in child survival, nutrition and school enrollment. China’s score rose 80 points, from 861 to 941, due to reductions in child deaths and malnutrition. Indonesia lifted its score 71 points, from 721 to 792 by improving child health and getting more children into school. And Vietnam’s score is up 67 points, from 764 to 831, due to significant reductions in stunting.

In Latin America and the Caribbean, the most progress was made by Haiti and Nicaragua, with 98- and 97-point increases, respectively. Haiti’s score rose from 620 to 718. Nicaragua’s score rose from 698 to 795. Both countries improved child survival and school enrollment. Bolivia achieved an 81-point increase, from 685 to 766, by cutting under-5 mortality and stunting in half. Ecuador rose 78 points, from 739 to 817, primarily by getting more children into school. Colombia, Guatemala and Peru all had score increases in the 65- to 75-point range. The biggest driver of progress in Colombia was the decline in child homicide. Guatemala’s score increase was due to fewer adolescent births, child deaths and children out of school. Peru cut its stunting rate by 58 percent.

In Eastern Europe and Central Asia, Tajikistan achieved a 124-point increase, rising from 718 to 842, due to improvement in child survival and nutrition. Uzbekistan’s score rose 98 points, from 789 to 887, primarily because of improvements in child health and survival. Kyrgyzstan’s score is up 84 points, from 748 to 832, due to impressive reductions in stunting. Bosnia and Herzegovina’s score increased 77 points, from 863 to 940, because displacement is down significantly. Ukraine’s score is up 65 points, from 867 to 932 due to improvements in child survival. And Georgia raised its score 68 points, from 815 to 883, by getting more children into school and improving child health.

In the Middle East, progress for children since 2000 has been greatly affected by continued violence and conflict. Iraq’s score is up 82 points, from 686 to 768, due to improvements on every indicator but displacement and adolescent fertility. Jordan, currently the home of millions of refugee children, increased its score 52 points, from 857 to 909. Child deaths, malnutrition, child marriage and adolescent births are all down by more than a third in Jordan.

point to a brighter future for many of Niger’s children.Many other countries in sub-Saharan Africa also have

made tremendous progress since 2000. Burkina Faso achieved a 220-point score increase, from 345 to 565, by improving child survival and school enrollment. Zambia’s score is up 201 points, from 422 to 623, due mainly to improvements in child survival. Liberia is up 182 points, from 417 to 599, due to 60 percent fewer deaths under age 5. Kenya, Malawi, Mali, Mozambique and Uganda all increased their scores by about 160 points or more. Improvements in children’s health and survival were the main drivers of progress in these countries as well. Uganda also significantly cut teen births.

In South Asia, Bhutan achieved a 194-point increase,

Sabreen, age 15, dropped out of school in fourth grade to help support her family in Egypt. She later enrolled in Save the Children’s Youth in Action program to improve her reading and math skills. After graduating, she began a business raising livestock.

Photo: Joseph Raouf / Save the Children

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• Venezuela, experiencing a socioeconomic and political crisis since 2010, has a score drop of 32 points, from 739 to 707. The under-5 mortality rate has risen 40 percent and child homicide is up 60 percent. Displacement has also risen sharply.

• Trinidad and Tobago’s score fell 29 points, from 885 to 856. Chronic malnutrition has led to a doubling of the stunting rate (from 5 to 11 percent of children under age 5) and data suggest the child homicide rate has quadrupled, from 4 to 16 deaths per 100,000 children.

See the 2000-2019 Progress Rankings, 2019 Country Rankings, the Complete End of Childhood Index (pages 19-25) and an explanation of the methodology, beginning on page 47 of the full report.

Developed countries made more modest gains and we often see rising inequality despite overall progress. The biggest score increases are in Latvia and Estonia (both up 40 points from 927 to 967) and Lithuania (up 39 points from 934 to 973). Child mortality is down more than 70 percent in Latvia and Estonia. Lithuania made good gains across five indicators.

Only three countries have seen a decline in their scores since 2000:

• Syria, now in its ninth year of war, has lost 151 points from its 2000 score, dropping from 794 to 643. Threats to childhood have risen steadily, with significant increases in malnutrition, children out of school and displacement. In 2000, there was almost no forced displacement in Syria. Today, 75 percent of the population is displaced from their homes by the conflict.

Narom has a checkup with midwife Soeung Sokha, who is part of an outreach team that goes to villages every month in Stung Treng Province, Cambodia. The team provides prenatal care, contraception, vaccinations and promotes health awareness.

Photo: David Wardell / Save the Children

1The MDG agenda – Launched in 2000, the Millennium Development Goals (MDGs) galvanized a 15-year global campaign to end poverty in all

its forms. This was the first-ever global strategy with quantifiable targets to be agreed upon by all United Nations member states. Thanks to concerted global, regional, national and local efforts, the MDGs saved the lives of millions and improved conditions for many more.

A recent Brookings Institution study found as many as 19 million extra child lives – most of them in Africa – were saved because of MDG-accelerated action.6 Major increases in rates of progress also resulted in as many as 111 million more children completing primary school and at least 471 million extra people being lifted out of extreme poverty.7 And yet, for all these gains, progress was uneven. Extreme poverty and inequalities persist. This is especially true for the roughly 1.5 billion people in conflict-affected countries and on the extreme margins of society who benefited least from the goals.8

2Government commitment – Strong political leadership at the national level – among heads of government and key policymakers – has played a

crucial role in helping millions more children survive and thrive.9 In Ethiopia, for example, the nation’s steadfast commitment and leadership over several decades to save the lives of newborns in both urban and remote rural areas has resulted not only in global recognition of the country’s advances, but also the recent appointment of its former top health administrator as the head of the World Health Organization. Of course, changes in government can undermine such efforts, but in countries like Bangladesh, Colombia and Ethiopia, progress has continued despite changes in leadership.10

In addition, in sharp contrast to 2000, more national governments recognize the value of increased social investment and poverty reduction and have created enabling legislation that addresses these issues. Progress against child labor in Brazil and Mexico, for example, would not have happened without active government policies.11 Several countries – including Burkina Faso, India, Malawi and Sierra Leone – have recently created legislation addressing the basic right of children not to be married at an early age. And Ghana and Sierra Leone are the latest countries to take important steps to provide

children with a free and compulsory education and set a minimum age for employment, though implementation of these policies remains challenging in both countries.

3Social investment and economic growth – Economic growth on its own does not guarantee greater resources for social investment in children’s

programs, but a number of countries have used additional resources resulting from economic growth to create highly effective programs benefitting children (for example, Bangladesh, Brazil, Ethiopia and Vietnam).12 Economic growth has driven malnutrition reductions in China and Mongolia and child labor reductions in Central Asia. In addition, revising fiscal and tax policies and making them more equitable can boost household incomes, providing additional funds to parents to pay for their children’s health care, nutrition and education.

Conditional cash transfers are another social protection strategy that has proven effective in many countries. Governments or organizations transfer money to people who meet certain criteria, such as enrolling children in school or receiving vaccinations. Food and other incentives have also been used this way. For example, in Bangladesh, girls received incentives to delay marriage, avoid teenage childbearing and stay in school.13

4Improved planning and implementation – Policy commitments are important but they require detailed and coordinated programs to succeed.

The most effective programs often involve a number of sectors participating toward the same goal while seeking support and buy-in from local communities and major donors. Practitioners have found that coordinated investments in education, health, poverty reduction, water and sanitation (i.e., “whole systems” approaches) can have a much greater impact on improving the lives of children than interventions from individual sectors.14 India’s comprehensive approach to tackling child marriage, for example – including policy reforms and investments in education, livelihoods and community mobilization for change – has been the key to its success. Similarly, multisectoral programs have been critical drivers of nutrition gains in Ethiopia and across Africa.

Timing is also important. Typically, investments in education come first and support later gains in health and

10 Factors Driving Change for Children Since 2000 Here are 10 key factors that have contributed to global progress

for children in recent decades.


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tuberculosis, to name only a few. Today more than 90 percent of people in 131 countries have been vaccinated against many of these diseases.22 Progress also requires that countries themselves take ownership of their own development, and as this report’s case studies illustrate, many developing countries are doing just that.

7 Empowering women and young girls – Advances in girls’ education (including equal access to primary school), falling fertility rates, delays

in marriage and first pregnancy, greater participation in the labor market, and a stronger political voice all represent major advances for women since the year 2000. And not surprisingly they have had a direct and major impact on the health, social and economic well-being of women and their children. As this report shows, rising education rates among women and girls have been critical to improvements in child health in Bangladesh and child protection in Afghanistan and India.23

Empowering women and girls also leads to strengthened economies and more equitable societies.24 Investing in education programs for girls and increasing the age at which they marry can return $5 for every dollar spent.25 Investing in programs improving incomes for women can return $7 dollars for every dollar spent.26 And yet, despite this progress, gender inequalities remain pervasive in each and every dimension of sustainable development.27

8Women’s leadership – Since 1995, when the Beijing Platform for Action was adopted, the proportion of women serving in parliaments around

the world has more than doubled, growing from 11 percent that year to 24 percent in 2019.28 Women in government have gained ground in 90 percent of the 174 countries for which data are available for 1995 to 2019.29 The number of single or lower houses of parliament where women occupy 30 percent or more of the seats (the target identified in Beijing) has increased from 5 to 50, while those with 40 percent or more have jumped from 1 to 15. The number of male-only parliaments dropped, from 10 to 3. As of January 1, 2019, there were three countries with over half of parliamentary seats held by women: Rwanda (61 percent), Cuba (53 percent) and Bolivia (53 percent).30

Evidence is growing of the positive impact women’s participation has on policy outcomes for children and families and development outcomes more broadly.31 Issues like gender-based violence, equal pay, child care, health care, reproductive rights, family leave, violence against children and child marriage are increasingly on the political agendas of countries. A robust body of research shows that a greater proportion of women legislators has a profound impact on peace and security.32 Female legislators also tend to increase foreign aid, particularly for education and health.33 At the grassroots level, women and girls are leading efforts to end child marriage in India, Indonesia, Lebanon, Mexico, Pakistan, Senegal and other countries.34

nutrition. Throughout the planning and implementation process, governments need to acknowledge the role that NGOs and donors play in filling gaps that invariably develop in translating detailed plans into action.

5Reducing inequities – Progress in child well-being has often been greatest where there has been an explicit emphasis on directing resources

to and improving the situation of the poorest and most marginalized groups. Vietnam has targeted programs to disadvantaged minority ethnic groups. Bangladesh has worked to reduce sex differentials in child mortality and school enrollment, and Brazil has had success in reducing malnutrition and child mortality among the poorest quintiles and in the poorest parts of the country.15 Egypt, Mali, Malawi, Niger and Sierra Leone have done especially well at reaching the poorest children with lifesaving health interventions. All are examples of countries taking the extra step as they seek to improve the lives of their most marginalized citizens – including millions of children whose lives remain untouched throughout decades of progress.

Much remains to be done to reach the poorest children who tend to be the furthest behind. Studies by Save the Children and UNICEF suggest that global development goals would be reached faster with a focus on the most disadvantaged children and communities.16

6Development assistance – Global aid declined in the 1990s, but has doubled since 2000.17 Development assistance plays a key role in improving children’s

well-being, particularly in low-income countries. An analysis by the Overseas Development Institute and Save the Children found countries in sub-Saharan Africa that received the most aid over the period 1998-2008 also made the most progress in child well-being.18

Targeting aid to children not only improves their lives in the short term, but also can pay huge dividends for a poor country’s economy over the longer term. One recent study found that spending $1 on childhood vaccines in a low-income country can generate as much as $44 in future savings.19 Other studies have shown that girls’ education can be the single best investment a poor country can make to improve its economic future.20 Early childhood care and development interventions also promise high rates of return to families, societies and nations.21

Of course, aid alone will not drive progress. Aid is most effective for children where national commitments to child well-being already exist and can strengthen and facilitate the implementation of effective programs and services. It often takes innovative initiatives – coupled with good local governance, political commitment and donor support – to ensure major progress. Consider the dramatic reduction in children’s deaths due to infectious diseases. In many of the world’s poorest neighborhoods, local physicians with government support have worked tirelessly with global alliances like Gavi, the Vaccine Alliance, to help children survive malaria, diphtheria, tetanus, pertussis, HIV and


9New technologies – Since 2000, the spread of mobile phones, computers and the Internet have transformed the way people live, work and interact.

Nearly the entire world population (96 percent) now live within reach of a mobile cellular network, up from 58 percent in 2001.35 And more than half of the world’s population is now online, up from just over 6 percent in 2000.

New, compelling evidence shows digital solutions are positively linked to progress on most (11 of 17) Sustainable Development Goals.36 Information and communications technologies (ICTs) have had a positive impact on economic growth, boosting incomes for people from all segments of society. There is growing evidence that ICTs have also contributed to improvements in child survival, health and well-being.

Telemedicine is making medical advice and treatment options available to people no matter where they live. Digital health platforms are being used by frontline health workers to diagnose and treat pneumonia, remind parents about actions that keep their babies healthy, and improve the coordination of vaccination campaigns and bed net distributions to prevent mosquito bites that spread malaria. Mobile phones are being used to register births,

improve early diagnosis of HIV in infants, monitor malnutrition in children and to educate individuals about family planning, adolescent health and prenatal care. During the recent Ebola outbreak in Sierra Leone, mobile phones were used to send emergency alerts, support health worker responses and increase access to help lines.

Digital tools and technologies are being used to improve livelihoods (for example, e-commerce platforms help expand market opportunities and mobile banking allows poor families to save and gain access to credit).

ICTs are also increasing access to quality education and promoting learning. This progress has been especially valuable for girls, refugees, children with disabilities and others who might otherwise be out of school.37,38,39,40,41

10 Social media – Facebook, Twitter, YouTube, Instagram and other social media platforms have spread around the world with remarkable speed.

The Pew Research Center surveyed adults in 37 countries and found social media usage varied from a high of 75 percent in Jordan to a low of 20 percent in Tanzania and India.42 Across the 19 developing countries surveyed, 53 percent of adults said they used social media, up from 34 percent just five years earlier.

Photo: Victoria Zegler / Save the Children

Niger, one of the poorest countries in the world, has made tremendous progress since 2000 in improving conditions for children. A significant portion of Niger’s national budget during this period has come from foreign aid (45% in 2002 and 15% in 2017).51 The United States has been the largest donor, contributing $437 million in 2018.52


social activism, boost economic activity, facilitate disaster response and relief, bolster civic engagement, enhance advocacy efforts and mobilize for peace. The public profile of child marriage, for example, has been boosted through increased media attention globally.47 Similarly, socially conscious consumerism may be contributing to declines in child labor.48

While there are important concerns about the social, political and economic fallout from the spread of digital activities – for example, misuse of social media that encourages violence, bullying and suicide – most experts believe the good outweighs the bad.49,50

Social media has had a huge impact on how people communicate with one another and access information. By giving a platform to anyone who wants to use it, social media has the potential to open and democratize societies.43 It can facilitate discussions, inspire action and vastly speed up the diffusion of information, ideas, practices, values and social norms that support positive change.44 Children and adolescents are using social media to amplify their voices and seek solutions to problems affecting them and their communities.45

There is some evidence that social media has had a positive impact on global development.46 It has been used to support greater engagement in health issues, promote

In Indonesia, Nurul participates in a Save the Children employment skills training program to improve her future opportunities and reduce her risk for exploitive labor.

Photo: Susan Warner / Save the Children


Recommendations

• Increase investments in children – To achieve the SDGs and ensure that all children have access to quality basic services, including protection and social protection services, governments (including donor nations) need to raise the necessary resources. Governments must ensure these resources reach excluded children in keeping with the focus on public investment in children outlined by the UN Committee on the Rights of the Child. Improved public investment to assist excluded children must include the removal of cost barriers to services as well as measures to ensure minimum financial security for all children through child-sensitive social protection. Children who are furthest behind must be identified and prioritized in terms of investments, service provision and decision making.

• Take action to ensure all children are treated equally – This includes ending discriminatory policies, norms and behaviors such as preventing girls from accessing health services or denying education to a child because of their ethnicity or gender. To facilitate children accessing quality services, governments must also put in place systems to register every child at birth.

• Count and include all children, regardless of who they are or where they are from – Governments need to ensure that all children, especially excluded children, are counted in data that are used to measure progress on the SDGs. Data should be collected and disaggregated by age, economic group, gender, sex, race, ethnicity and geography or migratory status, and be reported publicly in accessible formats. In addition, excluded children – girls and boys – should participate in policy making and budgeting, and be supported to monitor progress and hold governments to account.

Putting those children who are furthest behind first is no easy task. It means collecting and reporting the data necessary to identify those children furthest behind, and then developing strategies and allocating resources to improve their health and education outcomes, protect them from violence and forced labor, and empower all of them, especially girls, to reach their full potential.

This year countries have the opportunity to renew their commitment to achieving the SDGs. In July, national representatives will gather for the annual High-Level Political Forum to review a subset of the SDGs, including three goals critical to children’s progress – providing access to quality education (SDG 4), reducing inequality (SDG 10) and promoting peaceful societies (SDG16). Later, in September, under the auspices of the United Nations General Assembly, world leaders will gather to report on where countries stand in achieving the SDGs by 2030 in a gathering now being referred to as the SDG Summit. The summit represents the first heads-of-state level meeting on the SDGs since they were adopted in 2015 and provides an opportunity for national leaders to reinvigorate their commitment and identify ways to accelerate progress.

This year, the United Nations marks the 30th anniversary of the Convention on the Rights of the Child. Save the Children believes that the SDGs are a necessary and critical step toward respecting and supporting children’s rights – especially those of girls – including their rights to health, education, and protection. The SDGs are also important in helping children become equal and active members of society.

WHAT WE MUST GUARANTEE FOR ALL CHILDREN As countries review progress towards the SDGs, Save the Children calls on policy makers to make three critical guarantees to ensure children are a priority in their specific plans:

In 2015, world leaders agreed to the United Nations Sustainable

Development Goals – a set of 2030 targets for eradicating extreme poverty

in all its forms. As part of this agreement, governments committed to a

Pledge to Leave No One Behind, which, if realized, should mean the pace

of change will be fastest for those left furthest behind.



• Donor governments must provide external financial support, including pledging new and additional resources to the Gavi Alliance in the upcoming replenishment conference in 2020.

• Countries must commit to investing in building strong primary health care systems that deliver high-quality, accessible services free at the point of use.

• Countries must commit to supporting health services that seek to leave no one behind and to address first those furthest from coverage.

• Countries must commit to public financing for health through fair revenue-pooling such as taxes and the elimination of out-of-pocket payments.

• Donor governments must commit to supporting countries to mobilize domestic resources to increase investment in achieving UHC and to increase efficiencies and transparency for the way health funds are spent, as well as to align their aid to build strong national systems.

• Countries must ensure the final UHC declaration includes references to essential services such as those that can prevent pneumonia (the largest infectious disease killer of children under the age of 5), improve nutrition (malnutrition remains the underlying cause of 45 percent of deaths in children under the age of 5), and ensure adolescent reproductive health. Globally, more than 13 million adolescents give birth each year. Adolescent mothers face a higher risk of maternal mortality and morbidity than older women, and their children face a higher risk of neonatal, infant, and child mortality and morbidity.

• Countries must build a workforce of community health workers as part of a system of UHC. This is an important step for low-resource settings. Countries must also have plans to invest in and empower community health workers.

2. Focus on child nutrition in planning for the 2020 Nutrition for Growth Summit

As part of the SDG framework, world leaders agreed to end all forms of malnutrition by 2030. First held in 2013, the Nutrition for Growth Summit brings together stakeholders, including country and donor governments, to invest in solutions to fight malnutrition and achieve the goal. The third summit will be held in Japan in 2020. Leading up to and at the Nutrition for Growth Summit 2020, donor and country governments should:

• Prepare to commit to making substantial financial commitments and to invest in costed national plans for addressing malnutrition in children under the age of 5. Plans should also include efforts to address maternal and adolescent nutrition.

A GLOBAL ACTION PLAN FOR CHILDRENTo further ensure that children remain a priority in achieving SDGs, Save the Children is calling on country governments, donor nations and other stakeholders to put a greater emphasis on ending child poverty, eliminating under-5 child mortality, helping all children have access to a quality education and improved learning outcomes, ending wars and conflicts and empowering all girls, no matter their race, creed or color, while also putting an end to child marriage. What steps can be taken now toward achieving these specific goals for children? Here’s Save the Children’s own set of recommendations for a global action plan for children.

Steps to address child poverty:

• All countries should adopt a national action plan to reduce and eliminate child poverty, together with dedicated budgets and monitoring systems that track improvements in poverty-related deprivations among girls and boys of all ages.

• All governments should ensure that children in poverty (and their families) benefit from universal social protection measures, such as child grants, and should expand program coverage as quickly as possible to reach all children who are poor.

Steps to ensure no child dies before age 5:Sustainable Development Goal 3 is a commitment to ensure healthy lives, including ending preventable child deaths. To achieve this goal, world leaders, donors and other stakeholders must commit to the following key action steps:

1. Achieve universal health coverage

Universal health coverage (UHC) would ensure all citizens have access to affordable, quality care regardless of their wealth, ethnicity, gender or location and without being pushed into financial hardship or denied services because of how they are paid for. It is a way forward for achieving the Health for All goal under the SDG framework. This year (2019) provides an opportunity for countries to recommit or pledge concrete steps toward achieving UHC.

In September, world leaders will gather for the UN High-Level Meeting on Universal Health Coverage to discuss ways to achieve this goal under the auspices of the UN General Assembly. The final outcome document should be a roadmap to help guide national governments, civil society, donors and the private sector to work together to achieve UHC. This roadmap must include steps countries will take to overcome remaining barriers to ensuring no child dies before age 5, including:


Photo: Charlie Forgham-Bailey / Save the Children

In the Democratic Republic of the Congo, baby Joy has pneumonia. She is being examined and treated by head nurse Hubert Matondo at a health center on the outskirts of Kinshasa.

3. Increase resources to end pneumonia deaths among children

While other major causes of child deaths such as diarrhea and malaria have fallen, pneumonia remains the largest infectious killer of children under the age of 5. To achieve the goal of ending preventable child deaths by 2030, world leaders must increase their attention to pneumonia and take concrete steps to prevent and treat it.

Specifically, Save the Children calls for:

• High-burden countries to develop pneumonia action plans that can be integrated into plans to achieve UHC

• Stakeholders to improve case management of pneumonia by strengthening health systems

• Stakeholders to aim to achieve universal immunization by ensuring that the pneumococcal conjugate vaccine (PCV) is available, accessible and affordable.

• Make current investments in nutrition more targeted and effective through better tracking, analysis and reporting, ensuring they are age- and gender-responsive, and by building strong accountability mechanisms to ensure investments reach those that are most vulnerable and in need.

• Develop targets (for those countries and donor governments without targets) to demonstrate progress toward meeting the globally agreed upon World Health Assembly nutrition targets.

• Ensure that governments incorporate the World Health Organization’s International Code of Marketing of Breast Milk Substitutes and distributors of breast milk substitutes publicly commit to upholding the Code and its subsequent resolutions. Governments should agree to meet targets set to achieve full compliance and to integrate subsequent resolutions fully into their laws and regulations.

Photo: Andrew Pacutho / Save the Children

In rural Uganda, Save the Children has trained teachers to use participatory learning approaches that make it fun for children to build literacy and math skills.

• Provide sufficient, gender-responsive and more equitable allocation of public resources to deliver safe, inclusive and equitable quality education, with a focus on those left behind.

• Ensure that donor governments commit to supporting countries to mobilize domestic resources to increase investment in education.

• Advocate for G20 leaders to commit to bring reforms in the global tax system that will enable countries to expand their tax base to increase domestic budget.

Steps to ensure all children have access to quality learning and improved learning outcomes:Sustainable Development Goal 4 is the commitment to ensure inclusive and equitable quality education for all. To achieve this goal, world leaders, donors and other stakeholders must commit to the following:

• Create national plans to ensure that all girls and boys complete free, equitable, safe and quality basic education leading to relevant and effective learning outcomes, including literacy, numeracy and social-emotional skills.


• Ensure that donor governments provide external resources and contribute to multilateral institutions such as the Global Partnership for Education and Education Cannot Wait.

• Follow through on G7 commitments to close the gap in access to education during conflict and crisis, and for refugees and the internally displaced (especially for girls), including through prioritizing a gender-responsive approach across the continuum of immediate humanitarian response and long-term development programming, and by identifying and addressing the specific gender-related barriers faced by girls in accessing education.

Steps to stop the war on children:One in five children in today’s world lives in an area affected by conflict, and the lack of practical help on the ground to keep children safe or help them recover from harm is a disgrace. Eglantyne Jebb – who founded Save the Children 100 years ago – said “Every war is a war against children.” A century later, the world is still failing to protect our most vulnerable from the horrors of that war.

The war on children will only stop when all of us – from citizens and community leaders to military commanders and heads of state – respect the idea that children should always be off-limits in war. We can help make the war on children stop if we work together, and force world leaders to listen and act decisively.

Specifically, Save the Children is calling on governments to do one or more of the following – depending on national context:

• Uphold international standards by strengthening child protection principles in military doctrine and trainings, regulating and improving transparency on international arms transfers, and committing to sign and implement international standards and laws critical to protecting children, including the Safe Schools Declaration, Arms Trade Treaty, Optional Protocol to the Convention on the Rights of the Child, and Paris Principles and Commitments.

• Hold perpetrators of crimes against children to account through judicial and political mechanisms and support international and domestic mechanisms to prosecute cases of violations of children’s rights in conflict.

• Take practical action to protect children and support their recovery by increasing multi-year investments in humanitarian child protection, ensuring mental health and psychosocial support for children and their families are well resourced and mainstreamed, increasing investments in education and programs to address sexual and gender-based violence, and including children in peacemaking and peacebuilding initiatives.

Steps to empower all girls and end child marriage: As this report shows, persistent structural gender inequality, including discrimination against girls, remains a barrier to achieving many of the SDGs. The goals highlight that gender equality is not only a fundamental human right, but a necessary foundation for a peaceful, prosperous and sustainable world. Simply put: we will not be successful in tackling the biggest development challenges of our time, for and with the most deprived children, without a priority focus on and investment in gender equality. Save the Children calls on country governments and donors to:

• Be held accountable to girls for accelerating progress for advancing girls’ rights in order to end child marriage and its consequences and increase gender equality. This includes commitments to: – Accelerate action to address child marriage at national, regional, and international levels through utilization of transparent accountability mechanisms. – Ensure development and implementation of costed national action plans to end child marriage and ensure the meaningful participation and engagement of girls and community leaders – traditional and religious – in the development, implementation, monitoring and evaluation of such plans.

• Increase donor and national government investment to end child marriage and mitigate its consequences through gender-responsive budgeting across sectors and stand-alone financing for gender equality, including increased funding to support the provision of and access to sexual and reproductive health services and information, protection from all forms of violence, and safe, quality education for the most deprived and marginalized girls.

• Work together to empower girls as agents of change in their own lives and communities and transform patriarchal laws and social norms that allow and accept child marriage and other forms of sexual and gender-based violence.

• Develop and maintain a comprehensive database on child marriage in humanitarian contexts to fill current gaps that hamper addressing comprehensively the drivers of the practice as well as the needs of already married girls.



Photo: Talitha Brauer / Save the Children

Rabiou, 19 months old, was treated for malnutrition at the stabilization center funded by Save the Children in Aguie hospital, Niger.

COUNTRY2000 END

OF CHILDHOOD INDEX SCORE

2019 END OF CHILDHOOD INDEX SCORE

CHANGE IN SCORE

2000-2019

DR Congo 472 556 84Kyrgyzstan 748 832 84Namibia 676 760 84Iraq 686 768 82Bolivia 685 766 81China 861 941 80Iran 789 869 80State of Palestine 784 863 79Ecuador 739 817 78Bosnia & Herzegovina 863 940 77Sudan 539 615 76Djibouti 657 732 75Guatemala 566 639 73Indonesia 721 792 71Kazakhstan 864 933 69Peru 766 835 69Colombia 693 761 68Georgia 815 883 68Oman 857 925 68Vietnam 764 831 67Ukraine 867 932 65Turkmenistan 840 902 62Azerbaijan 789 849 60Botswana 741 800 59Honduras 624 682 58United Arab Emirates 874 931 57Algeria 851 907 56Armenia 852 908 56Russia 884 940 56Paraguay 748 803 55Romania 865 920 55Saudi Arabia 873 928 55Costa Rica 846 900 54Mexico 772 826 54Bahrain 905 958 53Jordan 857 909 52Cuba 867 918 51El Salvador 694 745 51Mauritius 869 919 50Lebanon 878 926 48Sri Lanka 867 915 48Suriname 812 860 48Croatia 919 965 46Dominican Republic 748 794 46Kuwait 896 942 46Samoa 868 911 43Bulgaria 882 923 41Jamaica 816 857 41Moldova 827 868 41Estonia 927 967 40Latvia 927 967 40Lithuania 934 973 39Tunisia 891 929 38Philippines 763 800 37Serbia 890 927 37Bahamas 866 901 35Egypt 798 833 35Hungary 928 963 35Argentina 848 881 33Papua New Guinea 642 675 33

COUNTRY2000 END



CHANGE IN SCORE

2000-2019

Sierra Leone 345 591 246Rwanda 503 744 241Ethiopia 414 651 237Niger 167 402 235Burkina Faso 345 565 220Angola 369 581 212Guinea-Bissau 388 597 209Zambia 422 623 201Timor-Leste 526 725 199Bhutan 617 811 194Afghanistan 411 596 185Liberia 417 599 182Eritrea 429 606 177Kenya 573 747 174Mozambique 394 567 173Equatorial Guinea 411 581 170Malawi 446 615 169Guinea 366 531 165Senegal 528 691 163Uganda 523 683 160Mali 271 430 159Bangladesh 575 728 153Cambodia 606 755 149Burundi 530 676 146Maldives 774 917 143DPR Korea 764 906 142Nepal 543 685 142Ghana 623 763 140India 632 769 137Madagascar 463 596 133Sao Tome & Principe 618 751 133Chad 277 408 131South Africa 639 769 130Cameroon 457 582 125Côte d’Ivoire 483 608 125Tajikistan 718 842 124Gabon 664 775 111Mongolia 766 877 111Tanzania 493 604 111Eswatini 637 747 110Nigeria 395 504 109Zimbabwe 569 677 108Lesotho 472 579 107Yemen* 548 652 104South Sudan 358 461 103Togo 576 679 103Myanmar 684 786 102Congo 614 715 101Laos 543 643 100Albania 809 908 99Haiti 620 718 98Uzbekistan 789 887 98Benin 534 631 97Nicaragua 698 795 97Mauritania 487 582 95Gambia 571 661 90Morocco 774 864 90Comoros 597 684 87Pakistan 540 626 86Turkey 818 904 86

Few children missing out on childhoodSome children missing out on childhoodMany children missing out on childhoodMost children missing out on childhoodNearly all children missing out on childhood

* Most of the available data for these countries predate escalations of violence and do not reflect the harsh realities for children in these settings.

Coloring reflects the extent to which children are missing out on childhood. For details, see Methodology and Research Notes in the full report.

Progress Rankings 2000-2019


COUNTRY2000 END



CHANGE IN SCORE

2000-2019

Portugal 945 978 33Qatar 900 933 33United States 909 941 32Solomon Islands 658 689 31Thailand 829 859 30Cabo Verde 811 840 29New Zealand 939 968 29Guyana 759 786 27Saint Vincent & the Grenadines 842 869 27Uruguay 850 877 27Iceland 952 978 26North Macedonia 876 900 24United Kingdom 948 972 24Vanuatu 774 798 24Finland 962 985 23Marshall Islands 749 772 23Brazil 785 806 21Ireland 961 982 21Greece 944 964 20Israel 954 974 20Italy 960 980 20Poland 948 968 20Belize 782 801 19Montenegro 902 921 19Slovenia 966 985 19Somalia 449 468 19Belarus 933 951 18Australia 958 975 17Cyprus 960 977 17Singapore 972 989 17Canada 955 971 16Norway 969 985 16Brunei Darussalam 892 907 15Chile 901 916 15France 959 973 14Luxembourg 960 974 14Spain 963 977 14Belgium 966 979 13Germany 969 982 13Panama 779 792 13Sweden 974 986 12Switzerland 963 975 12Republic of Korea 969 980 11Barbados 905 915 10Denmark 961 971 10Central African Republic 385 394 9Malaysia 883 890 7Malta 954 961 7Fiji 870 876 6Japan 968 973 5Saint Lucia 878 881 3Tonga 908 910 2Seychelles 864 865 1Trinidad & Tobago 885 856 -29Venezuela 739 707 -32Syria* 794 643 -151

PROGRESS RANKINGS 2000-2019

Few children missing out on childhoodSome children missing out on childhoodMany children missing out on childhoodMost children missing out on childhoodNearly all children missing out on childhood

* Most of the available data for these countries predate escalations of violence and do not reflect the harsh realities for children in these settings.

Coloring reflects the extent to which children are missing out on childhood. For details, see Methodology and Research Notes in the full report.


End of Childhood Index Rankings 2019

Index scores reflect the average level of performance across a set of eight indicators related to child health, education, labor, marriage, childbirth and violence. The only reason a country was not included in this analysis was insufficient data (e.g., the country was missing values for three or more indicators). To see the underlying dataset, including data gaps, turn to pages 50-53 in the full report. Performance bands reflect the extent to which children are missing out on childhood. For details, see Methodology and Research Notes in the full report.

* Data collection in times of conflict is difficult and dangerous. Latest available data for conflict-affected countries often predate escalations of violence and do not capture the harsh realities for children in these settings. In Syria and Yemen, for example, recent evidence suggests rates of child labor and child marriage have risen. These trends are not reflected in the data or index ranking.

** Although relatively few children in these countries are missing out on childhood, the absolute number of children missing out likely totals in the millions. This is especially true in more populous countries at the bottom of the performance band (e.g., United States, Russia).

Few children missing out on childhood**Some children missing out on childhoodMany children missing out on childhoodMost children missing out on childhood∧ Score is up from last year∨ Score is down from last year

RANK COUNTRY SCORE1 Singapore 989 ∧2 Sweden 986 ∧3 Finland 985 ∧3 Norway 9853 Slovenia 985 ∨6 Germany 982 ∧6 Ireland 982 ∧8 Italy 9808 Republic of Korea 98010 Belgium 979 ∧11 Iceland 978 ∨11 Portugal 978 ∨13 Cyprus 977 ∨13 Spain 97715 Australia 97515 Switzerland 97517 Israel 974 ∧17 Luxembourg 974 ∧19 France 973 ∨19 Japan 97319 Lithuania 973 ∧22 United Kingdom 972 ∧23 Canada 971 ∧23 Denmark 97125 New Zealand 968 ∧25 Poland 96827 Estonia 967 ∧27 Latvia 967 ∧29 Croatia 96530 Greece 964 ∨31 Hungary 963 ∧32 Malta 96133 Bahrain 958 ∧34 Belarus 951 ∨35 Kuwait 942 ∨36 China 941 ∧36 United States 941 ∨38 Bosnia & Herzegovina 940 ∨38 Russia 940 ∨40 Kazakhstan 933 ∧40 Qatar 933 ∨42 Ukraine 93243 United Arab Emirates 931 ∨44 Tunisia 929 ∧45 Saudi Arabia 928 ∧46 Serbia 927 ∨47 Lebanon 926 ∧48 Oman 925 ∨49 Bulgaria 923 ∨50 Montenegro 921 ∧51 Romania 920 ∧52 Mauritius 919 ∧53 Cuba 918 ∧54 Maldives 917 ∨55 Chile 916 ∧56 Barbados 915 ∧56 Sri Lanka 915 ∧58 Samoa 91159 Tonga 910 ∨

RANK COUNTRY SCORE60 Jordan 909 ∨61 Albania 908 ∧61 Armenia 908 ∨63 Algeria 907 ∧63 Brunei Darussalam 907 ∧65 DPR Korea 906 ∧66 Turkey 90467 Turkmenistan 902 ∧68 Bahamas 901 ∨69 Costa Rica 900 ∧69 North Macedonia 90071 Malaysia 890 ∨72 Uzbekistan 887 ∧73 Georgia 883 ∨74 Argentina 881 ∨74 Saint Lucia 881 ∧76 Mongolia 877 ∨76 Uruguay 877 ∧78 Fiji 876 ∨79 Iran 869 ∧79 Saint Vincent & the Grenadines 86981 Moldova 868 ∧82 Seychelles 865 ∨83 Morocco 864 ∧84 State of Palestine 863 ∨85 Suriname 860 ∧86 Thailand 859 ∨87 Jamaica 857 ∨88 Trinidad & Tobago 856 ∨89 Azerbaijan 849 ∧90 Tajikistan 842 ∧91 Cabo Verde 84092 Peru 835 ∧93 Egypt 833 ∧94 Kyrgyzstan 832 ∧95 Vietnam 831 ∧96 Mexico 826 ∧97 Ecuador 817 ∧98 Bhutan 811 ∧99 Brazil 806 ∨100 Paraguay 803 ∨101 Belize 801 ∨102 Botswana 800102 Philippines 800 ∧104 Vanuatu 798 ∨105 Nicaragua 795 ∧106 Dominican Republic 794 ∧107 Indonesia 792 ∨107 Panama 792109 Guyana 786 ∨109 Myanmar* 786 ∨111 Gabon 775 ∨112 Marshall Islands 772113 India 769 ∧113 South Africa 769 ∨115 Iraq* 768 ∧116 Bolivia 766 ∧117 Ghana 763 ∧118 Colombia 761 ∧

RANK COUNTRY SCORE119 Namibia 760 ∨120 Cambodia 755 ∧121 Sao Tome & Principe 751 ∨122 Eswatini 747 ∨122 Kenya 747 ∧124 El Salvador 745 ∨125 Rwanda 744 ∨126 Djibouti 732 ∧127 Bangladesh 728 ∧128 Timor-Leste 725 ∧129 Haiti 718 ∨130 Congo 715 ∨131 Venezuela 707 ∨132 Senegal 691 ∧133 Solomon Islands 689 ∧134 Nepal 685 ∧135 Comoros 684 ∨136 Uganda 683 ∨137 Honduras 682 ∧138 Togo 679 ∨139 Zimbabwe 677 ∨140 Burundi 676 ∧141 Papua New Guinea 675 ∨142 Gambia 661 ∧143 Yemen* 652 ∧144 Ethiopia 651 ∨145 Laos 643 ∨145 Syria* 643 ∨147 Guatemala 639 ∧148 Benin 631 ∧149 Pakistan 626 ∨150 Zambia 623 ∨151 Malawi 615 ∨151 Sudan 615 ∨153 Côte d'Ivoire 608 ∨154 Eritrea 606 ∨155 Tanzania 604 ∨156 Liberia 599 ∨157 Guinea-Bissau 597 ∨158 Afghanistan 596 ∧158 Madagascar 596 ∧160 Sierra Leone 591 ∧161 Cameroon 582 ∨161 Mauritania 582 ∨163 Angola 581 ∧163 Equatorial Guinea 581 ∨165 Lesotho 579 ∨166 Mozambique 567 ∨167 Burkina Faso 565 ∧168 DR Congo 556169 Guinea 531 ∧170 Nigeria 504 ∨171 Somalia 468 ∨172 South Sudan 461 ∨173 Mali 430 ∧174 Chad 408 ∨175 Niger 402 ∧176 Central African Republic 394 ∨


Coloring reflects prevalence: Moderate High Very high

Complete End of Childhood Index 2019CHILDHOOD ENDER CHILD DIES

CHILD IS SEVERELY

MALNOURISHEDCHILD IS OUT OF SCHOOL

CHILD BEGINS WORK LIFE

CHILD MARRIES

CHILD HAS A CHILD

CHILD IS A VICTIM OF EXTREME VIOLENCE

END OF CHILDHOOD INDEX 2019

INDICATOR

Under-5 mortality rate

(deaths per 1,000 live

births)

Child stunting (% children aged 0-59 months)

Out-of-school children of

primary and secondary

school age (%)

Children engaged in child labor

(% ages 5-17)

Adolescents currently

married or in union (% girls aged 15-19)

Adolescent birth rate (births per 1,000 girls aged

15-19)

Population forcibly

displaced by conflict

(% of total)†

Child homicide rate (deaths per 100,000 population aged 0-19)

2017 2013-2018+ 2013-2018+ 2013-2018+ 2013-2018+ 2016 2018 2016 Score (out of 1,000)

Rank (out of 176)

Afghanistan* 67.9 40.9 41.9 z 29.4 16.9 b 68.8 14.9 c 3.0 596 158

Albania 8.8 11.3 a 6.9 5.1 x,y 6.7 a 20.7 1.0 2.0 908 61

Algeria* 24.0 11.7 x 9.7 x,z 5.0 y 3.1 b 10.4 0.0 1.6 907 63

Angola 81.1 37.6 36.4 x 23.4 18.2 154.5 0.1 5.0 581 163

Antigua and Barbuda 7.4 … 18.9 … … 44.7 0.1 0.7 – –

Argentina 10.4 8.2 x 2.9 4.4 x,y 12.7 x 63.0 0.0 3.1 881 74

Armenia 12.6 9.4 7.1 x 8.7 y 4.6 24.0 0.8 0.6 908 61

Australia 3.5 2.0 x 2.4 … 0.5 b 13.3 0.0 0.4 975 15

Austria 3.6 … … … 2.7 x 7.2 0.0 0.2 – –

Azerbaijan 23.0 18.0 6.4 6.5 x,y 8.9 a,x 52.6 6.4 0.9 849 89

Bahamas 7.2 … 11.2 … 2.4 x 28.0 0.2 10.1 901 68

Bahrain 7.3 … 2.3 … 5.3 b,x 13.5 0.0 0.3 958 33

Bangladesh 32.4 36.1 17.4 4.3 y 32.4 x 84.4 0.0 1.5 728 127

Barbados 12.4 7.7 x 6.5 1.9 x,y 1.4 a,x 39.2 0.1 3.9 915 56

Belarus 3.7 4.5 x 2.4 1.4 x,y 7.4 x 18.0 0.1 0.5 951 34

Belgium 3.8 … 1.6 … 2.2 x 5.1 0.0 0.4 979 10

Belize 14.2 15.0 10.2 3.2 y 20.8 a 64.7 0.1 11.9 801 101

Benin 98.3 32.2 a 23.8 32.9 a 16.0 a 88.1 0.0 3.8 631 148

Bhutan 30.8 33.6 x 19.1 2.9 x,y 15.2 x 22.1 0.9 0.6 811 98Bolivia (Plurinational State of) 34.9 16.1 11.7 26.4 x,y 11.6 x 69.0 0.0 6.0 766 116

Bosnia and Herzegovina 5.7 8.9 x … 5.3 x,y 0.6 x 10.4 4.7 0.7 940 38

Botswana 37.6 31.4 x … 9.0 x,y 7.1 x 31.7 0.0 4.6 800 102

Brazil 14.8 7.1 x 7.2 6.6 y 15.1 x 62.7 0.0 17.7 806 99

Brunei Darussalam 10.5 19.7 x 9.1 … 3.1 b,x 10.9 0.0 1.0 907 63

Bulgaria 7.5 … 7.9 … 8.4 x 40.3 0.0 0.4 923 49

Burkina Faso 81.2 27.3 38.5 39.2 x,y 31.5 x 106.5 0.2 5.0 565 167

Burundi 61.2 55.9 20.6 26.3 x,y 5.9 a 27.4 6.3 4.1 676 140

Cabo Verde 17.4 … 20.5 6.4 x,y 8.1 x 74.7 0.0 4.4 840 91

Cambodia 29.2 32.4 22.5 x 19.3 y 15.6 49.9 0.1 0.7 755 120

Cameroon 84.0 31.7 22.6 47.0 20.1 108.8 1.1 6.2 582 161

Canada 5.1 … 2.4 … 1.7 9.8 0.0 0.7 971 23

Central African Republic 121.5 40.7 x 49.1 x 28.5 x,y 54.8 x 105.8 29.3 c 7.7 394 176

Chad 123.2 39.9 46.1 51.5 38.3 164.5 1.1 5.7 408 174

Chile 7.4 1.8 6.2 6.6 x,y 5.7 x 46.6 0.0 1.9 916 55

China* 9.3 8.1 7.6 z … 3.1 b 6.5 0.0 e 0.6 941 36

Colombia 14.7 12.7 x 7.9 7.8 y 12.7 49.5 16.1 c 20.9 761 118

Comoros 69.0 32.1 x 28.1 22.0 x,y 16.4 x 67.2 0.1 3.7 684 135

Congo* 47.5 21.2 11.0 x,z 23.3 16.1 a 114.1 3.4 4.4 715 130

Costa Rica 9.0 5.6 x 5.3 4.1 x,y 7.1 54.6 0.0 3.3 900 69

Côte d’Ivoire 88.8 21.6 30.9 31.3 a 18.4 a 133.4 0.2 6.7 608 153

Croatia 4.6 … 6.3 … 2.0 x 9.4 0.7 0.2 965 29

Cuba 5.4 … 6.6 … 11.1 45.0 0.2 1.3 918 53

Cyprus 2.7 … 3.0 … 3.1 x 4.7 0.0 0.5 977 13

Czech Republic 3.3 … … … 0.9 x 10.2 0.0 0.2 – –Democratic People’s Republic of Korea 19.0 19.1 a … 5.1 a 0.0 a 0.3 0.0 2.7 906 65

Democratic Republic of the Congo* 91.1 42.6 16.6 z 38.4 21.3 125.2 6.6 c 7.3 556 168

Denmark 4.3 … 3.8 … 3.5 x 4.2 0.0 0.3 971 23

Djibouti 61.7 33.5 x 52.9 7.7 x,y 2.6 b,x 19.4 0.3 3.4 732 126

Dominican Republic 29.9 7.1 10.8 12.8 18.1 96.1 0.0 5.3 794 106



COMPLETE END OF CHILDHOOD INDEX 2019

CHILDHOOD ENDER CHILD DIESCHILD IS

SEVERELY MALNOURISHED

CHILD IS OUT OF SCHOOL


CHILD MARRIES

CHILD HAS A CHILD



INDICATOR



births)




school age (%)


(% ages 5-17)




15-19)

Population forcibly


(% of total)†


2017 2013-2018+ 2013-2018+ 2013-2018+ 2013-2018+ 2016 2018 2016 Score (out of 1,000)

Rank (out of 176)

Ecuador 14.5 23.9 5.3 4.9 y 20.0 x 74.6 0.1 2.9 817 97

Egypt 22.1 22.3 8.0 7.0 14.4 b 51.0 0.0 2.2 833 93

El Salvador 14.5 13.6 22.5 8.9 y 16.3 70.3 3.3 17.9 745 124

Equatorial Guinea 89.6 26.2 x … … 22.0 x 157.9 0.0 1.0 581 163

Eritrea 43.1 50.3 x 62.7 … … 53.5 11.0 3.2 606 154

Estonia 2.7 … 4.5 … 4.4 x 13.3 0.0 0.3 967 27

Eswatini 53.9 25.5 21.8 7.3 x,y 3.7 78.5 0.0 10.8 747 122

Ethiopia 58.5 38.4 33.6 27.4 x,y 17.4 64.9 1.3 4.2 651 144

Fiji 25.3 … 7.8 x … 7.6 b,x 43.7 0.2 1.4 876 78

Finland 2.3 … 1.7 … 0.3 6.9 0.0 0.5 985 3

France 4.2 … 2.5 … 2.7 8.8 0.0 0.4 973 19

Gabon* 48.3 17.5 x 7.7 x,z 13.4 x,y 13.5 x 98.5 0.0 3.8 775 111

Gambia* 63.6 25.0 35.9 z 19.2 x,y 23.8 81.9 1.6 5.5 661 142

Georgia 10.8 11.3 x 2.0 4.2 y 10.6 x 47.1 7.8 1.1 883 73

Germany 3.7 1.3 x … … 0.4 6.8 0.0 0.3 982 6

Ghana 49.3 18.8 19.0 21.8 y 6.4 67.6 0.1 4.5 763 117

Greece 5.3 … 7.8 … 1.8 x 7.5 0.0 0.2 964 30

Grenada 16.7 … 10.5 … … 30.4 0.1 1.8 – –

Guatemala 27.6 46.5 28.6 25.8 x,y 19.8 72.5 0.5 10.4 639 147

Guinea 85.7 30.3 a 37.8 38.1 a 35.2 a 137.4 0.4 5.2 531 169

Guinea-Bissau* 84.2 27.6 30.6 z 51.1 11.4 87.2 0.3 6.9 597 157

Guyana 31.3 12.0 9.5 x 18.3 13.3 a 86.7 0.1 6.0 786 109

Haiti* 71.7 21.9 a 14.3 x,z 24.4 x,y 6.9 a 38.2 0.6 14.9 718 129

Honduras 18.2 22.7 x 30.1 14.1 y 22.6 x 72.2 2.7 18.3 682 137

Hungary 4.5 … 6.4 … 0.7 19.8 0.1 0.3 963 31

Iceland 2.1 … 4.9 … 0.4 7.3 0.0 0.7 978 11

India 39.4 38.4 20.2 11.8 x,y 15.2 a,b 24.5 0.0 1.3 769 113

Indonesia 25.4 36.4 14.2 6.9 x,y 12.8 x 48.0 0.0 2.8 792 107

Iran (Islamic Republic of) 14.9 6.8 x 6.8 11.4 x,y 21.1 b,x 25.7 0.2 c 1.4 869 79

Iraq 30.4 9.9 a 21.9 x 7.3 a 18.4 a,b 79.8 8.3 c 6.7 768 115

Ireland 3.5 … 0.2 … 1.1 x 10.1 0.0 0.3 982 6

Israel 3.6 … 1.9 … 2.5 b 9.7 0.0 0.8 974 17

Italy 3.4 … 2.4 … 1.5 x 6.2 0.0 0.2 980 8

Jamaica 15.2 6.2 … 3.3 x,y 3.4 x 54.4 0.1 15.0 857 87

Japan 2.6 7.1 x 1.7 … 0.5 b 4.2 0.0 0.1 973 19

Jordan 17.0 7.8 x … 1.7 y 11.0 b 23.3 0.1 1.5 909 60

Kazakhstan 10.0 8.0 0.9 2.2 x,y 6.0 28.4 0.0 1.2 933 40

Kenya 45.6 26.0 20.5 x … 12.0 81.8 0.0 2.5 747 122

Kiribati 54.6 … … … 15.8 x 17.2 0.0 6.9 – –

Kuwait 8.1 4.9 7.5 … 5.3 b,x 9.4 0.1 0.9 942 35

Kyrgyzstan 20.0 12.9 5.5 25.8 13.1 38.8 0.1 1.2 832 94Lao People’s Democratic Republic 63.4 33.0 a 19.2 42.5 a 23.5 a 63.3 0.1 3.9 643 145

Latvia 4.2 … 2.8 … 2.6 x 13.8 0.0 0.9 967 27

Lebanon 7.8 … 20.1 x 1.9 x,y 3.3 b,x 12.2 0.2 1.4 926 47

Lesotho 85.9 33.2 24.7 … 17.7 89.7 0.0 19.2 579 165

Liberia 74.7 32.1 49.7 20.8 x,y 14.3 128.8 0.2 5.9 599 156

Libya 12.4 21.0 x … … … 5.7 4.0 0.9 – –

Lithuania 4.3 … 0.8 … 2.1 x 11.4 0.0 1.0 973 19

Luxembourg 2.6 … 7.5 … 1.0 x 5.4 0.0 0.1 974 17

Madagascar* 44.2 49.2 x 29.2 x,z 22.9 y 33.7 x 111.7 0.0 4.4 596 158

Malawi 55.4 37.1 17.5 39.3 23.5 141.0 0.0 0.8 615 151

Malaysia 7.9 20.7 13.4 … 6.0 b,x 13.4 0.0 1.9 890 71

Maldives* 7.9 15.3 a 11.1 x,z … 3.8 a 6.5 0.0 1.3 917 54

Mali 106.0 26.9 a 46.0 55.8 38.9 a 171.1 1.2 c 6.9 430 173








CHILD MARRIES

CHILD HAS A CHILD



INDICATOR



births)




school age (%)


(% ages 5-17)




15-19)

Population forcibly


(% of total)†


2017 2013-2018+ 2013-2018+ 2013-2018+ 2013-2018+ 2016 2018 2016 Score (out of 1,000)

Rank (out of 176)

Malta 6.4 … 5.7 … 0.5 x 16.8 0.0 0.4 961 32

Marshall Islands 34.0 … 23.7 … 21.1 x 84.5 x,z 0.0 1.6 z 772 112

Mauritania 79.0 27.9 39.6 37.6 27.8 a,b 80.5 1.0 7.0 582 161

Mauritius 13.1 … 8.9 … 7.0 x 26.9 0.0 0.5 919 52

Mexico 13.4 12.4 10.4 12.4 15.4 61.4 0.1 4.9 826 96

Mongolia 17.2 10.8 8.6 x 17.3 4.9 24.2 0.2 1.4 877 76

Montenegro 3.5 9.4 7.2 12.5 2.1 12.1 0.2 0.5 921 50

Morocco 23.3 14.9 x 11.5 8.3 x,y 11.0 b,x 31.7 0.0 0.7 864 83

Mozambique 72.4 43.1 x 26.5 22.2 x,y 43.1 a 138.9 0.1 1.6 567 166

Myanmar 48.6 29.2 18.8 9.3 y 11.9 b 29.0 2.9 c 2.0 786 109

Namibia 44.2 23.1 15.1 x … 5.4 75.0 0.1 8.7 760 119

Nauru 33.0 24.0 x 22.0 … 18.3 x 94.0 z 0.0 … – –

Nepal 33.7 35.8 13.8 37.4 27.1 a 62.1 0.1 1.5 685 134

Netherlands 3.9 … … … 0.1 4.1 0.0 0.3 – –

New Zealand 5.3 … 1.5 … 0.5 b,x 20.6 0.0 0.7 968 25

Nicaragua 17.2 17.3 x 10.4 x … 22.4 x 86.9 0.1 5.2 795 105

Niger 84.5 42.2 51.6 30.5 x,y 59.8 x 194.0 0.8 c 7.5 402 175

Nigeria* 100.2 43.6 38.0 z 50.8 a 22.2 a 109.3 1.3 c 5.4 504 170

North Macedonia 13.7 4.9 x 15.7 x 12.5 x,y 4.3 x 16.6 0.2 0.4 900 69

Norway 2.6 … 2.1 … 0.1 5.7 0.0 0.2 985 3

Oman 11.3 14.1 3.9 … 3.3 a,b 7.9 0.0 1.9 925 48

Pakistan 74.9 47.2 a 40.8 … 13.5 a,b 37.7 0.2 6.5 626 149

Panama 16.1 19.1 x 16.8 2.5 y 14.1 a 82.8 0.0 9.6 792 107

Papua New Guinea 53.4 49.5 x 27.5 … 14.8 x 53.4 0.0 4.5 675 141

Paraguay 21.0 5.6 15.4 x 26.4 a 16.1 a 56.6 0.0 3.0 803 100

Peru 15.0 13.1 4.1 x 21.8 y 11.3 48.4 0.0 3.7 835 92

Philippines 28.1 33.4 6.1 11.1 x,y 8.5 a 59.9 0.5 c 3.5 800 102

Poland 4.7 … 5.3 … 1.2 x 13.0 0.0 0.2 968 25

Portugal 3.7 … 2.4 … 0.6 b,x 9.9 0.0 0.4 978 11

Qatar 7.6 … 10.7 … 4.0 a,b 10.2 0.0 3.8 933 40

Republic of Korea 3.3 2.5 x 3.1 … 0.4 b,x 1.7 0.0 0.4 980 8

Republic of Moldova 15.5 6.4 x 17.0 16.3 x,y 9.9 x 22.7 0.2 0.8 868 81

Romania 7.8 … 13.8 … 6.7 x 33.7 0.0 0.3 920 51

Russian Federation 7.6 … 3.4 … 7.5 x 22.5 0.1 1.5 940 38

Rwanda* 37.9 37.9 22.6 z 28.5 x,y 3.0 26.8 2.2 2.9 744 125

Saint Lucia 16.6 2.5 x 10.6 x 3.9 x,y … 41.3 0.6 5.1 881 74Saint Vincent and the Grenadines 16.2 … 3.5 … 16.7 x 50.1 1.3 4.4 869 79

Samoa 16.5 4.7 8.8 … 7.8 a 24.8 0.0 1.2 911 58

Sao Tome and Principe 32.4 17.2 10.9 26.0 15.3 96.3 0.0 4.1 751 121

Saudi Arabia 7.4 9.3 x 4.0 … 5.6 b,x 8.3 0.0 4.1 928 45

Senegal 45.4 16.5 a 39.3 23.0 23.3 a 74.9 0.3 4.4 691 132

Serbia 5.7 6.0 4.7 9.5 3.1 19.3 3.0 d 0.3 927 46

Seychelles 14.2 7.9 x 9.5 … … 57.8 0.0 1.5 865 82

Sierra Leone 110.5 26.4 a 26.1 39.0 a 15.3 a 115.6 0.1 6.4 591 160

Singapore 2.8 … 0.1 … 0.4 b,x 3.7 0.0 0.1 989 1

Slovakia 5.6 … … … 1.6 x 22.2 0.0 0.3 – –

Slovenia 2.1 … 2.8 … 0.5 x 4.3 0.0 0.1 985 3

Solomon Islands 20.6 31.6 31.3 x 47.8 y 11.4 a 47.8 0.0 1.9 689 133

Somalia* 127.2 25.3 x 48.7 x,z 49.0 x,y 24.6 b,x 102.2 25.8 c 3.1 468 171

South Africa 37.1 27.4 9.8 … 3.1 a 44.4 0.0 15.6 769 113

South Sudan 96.4 31.1 x 66.7 … 40.1 x 65.2 31.6 c 2.4 461 172

Spain 3.1 … 1.1 … x 3.5 8.7 0.0 0.2 977 13

Sri Lanka 8.8 17.3 6.4 1.0 y 6.0 a 14.8 0.8 0.8 915 56

State of Palestine 20.9 7.4 12.3 5.7 x,y 9.1 b 57.2 2.2 2.7 z 863 84



… Data are unavailable or outdated (i.e., pre-2005)+ Data refer to the most recent year available during the reference perioda Estimate from recent MICS or DHS (pending reanalysis)b Estimate does not include consensual unionsc There is evidence of recruitment and use of children (e.g., as child soliders)d Includes displaced populations from Serbia and Kosovoe Includes displaced populations of Tibetan originx Data refer to the most recent year available during the period 2005-2012y Data differ from the standard definition (interpret with caution)z Data are from the secondary source (interpret with caution)§ Includes Eastern and Southern Africa, West and Central Africa, Djibouti, Sudan

‡ Central and Eastern Europe and the Commonwealth of Independent States** Excludes China* To include as many countries as possible in the rankings, school attendance data for

these 20 countries were sourced from surveys because recent enrollment data were not available

† Includes refugees, asylum-seekers, internally displaced persons (IDPs), returnees (refugees and IDPs) and others of concern to UNHCR

Note: For indicator definitions, primary and secondary data sources, prevalence thresholds and regional classifications, see Methodology and Research Notes in the full report.






CHILD MARRIES

CHILD HAS A CHILD



INDICATOR



births)




school age (%)


(% ages 5-17)




15-19)

Population forcibly


(% of total)†


2017 2013-2018+ 2013-2018+ 2013-2018+ 2013-2018+ 2016 2018 2016 Score (out of 1,000)

Rank (out of 176)

Sudan 63.2 38.2 47.3 x 24.9 20.0 b 67.2 6.7 c 3.1 615 151

Suriname 19.6 8.8 x 15.8 4.1 x,y 11.8 x 46.7 0.0 3.5 860 85

Sweden 2.8 … 0.7 … 0.3 5.3 0.0 0.6 986 2

Switzerland 4.2 … 6.1 … 0.4 3.1 0.0 0.3 975 15

Syrian Arab Republic 17.0 27.5 x 45.0 4.0 x,y 9.7 b,x 39.5 74.5 c 1.0 643 145

Tajikistan 33.6 17.5 a 10.9 x 10.0 x 12.6 a 36.9 0.1 0.5 842 90

Thailand 9.5 10.5 12.4 x 8.3 x,y 14.1 a 51.8 0.0 2.0 859 86

Timor-Leste 47.6 45.6 a 19.7 … 8.2 a 45.6 0.0 4.6 725 128

Togo 72.9 27.5 21.6 27.9 12.7 89.6 0.1 4.8 679 138

Tonga 16.0 8.1 x 10.3 … 4.6 x 15.1 0.1 2.2 910 59

Trinidad and Tobago* 26.1 11.0 x 4.2 x,z 2.3 a,x,y 2.1 b,x 31.0 0.0 16.4 856 88

Tunisia* 13.0 10.1 x 13.3 x,z 2.1 x,y 1.2 b,x 7.6 0.0 0.6 929 44

Turkey 11.6 9.5 10.4 5.9 x,y 6.6 b 26.9 0.1 0.9 904 66

Turkmenistan* 47.3 11.5 0.4 z 0.3 6.0 24.8 0.0 1.5 902 67

Tuvalu 24.9 10.0 x 16.3 … 8.0 b,x 28.0 x,z 0.0 … – –

Uganda* 49.0 28.9 23.3 z 16.3 x,y 19.9 a 110.5 0.4 6.4 683 136

Ukraine 8.8 … 4.9 2.4 x,y 6.5 x 24.7 4.4 0.7 932 42

United Arab Emirates 9.1 … 5.1 … 6.7 b,x 28.2 0.0 1.7 931 43

United Kingdom 4.3 … 0.8 … 2.9 x 13.5 0.0 0.6 972 22United Republic of Tanzania 54.0 34.4 42.7 28.8 y 22.3 116.6 0.0 4.1 604 155

United States 6.6 2.1 x 3.4 … 5.8 x 20.6 0.0 3.4 941 36

Uruguay 8.2 10.7 x 6.2 7.9 x,y 7.4 55.4 0.0 3.6 877 76

Uzbekistan 22.5 19.6 x 6.3 … 4.9 x 16.7 0.0 0.5 887 72

Vanuatu 26.9 28.5 16.1 15.2 y 11.3 a 42.5 0.0 1.3 798 104Venezuela (Bolivarian Republic of) 30.9 13.4 x 17.3 … 15.8 x 85.8 2.7 23.8 707 131

Vietnam* 20.9 24.6 10.2 z 16.4 9.7 29.0 0.4 1.2 831 95

Yemen 55.4 46.5 28.9 22.7 x,y 16.7 b 61.8 7.6 c 2.8 652 143

Zambia* 60.0 40.0 22.2 z 40.6 x,y 16.9 86.0 0.0 5.5 623 150

Zimbabwe 50.3 26.8 24.9 … 19.6 105.8 0.2 8.3 677 139

GLOBAL AND REGIONAL AVERAGES+

Sub-Saharan Africa§ 75.5 33.9 31.7 29.4 23.0 122.0 2.3 5.4 593 –Eastern and Southern Africa 59.1 34.1 29.5 25.8 20.0 112.8 2.1 5.1 631 –

West and Central Africa 91.2 33.7 32.7 31.9 26.7 129.8 2.1 5.9 559 –Middle East and North Africa 23.0 15.0 17.9 6.9 12.8 41.0 4.7 2.5 829 –

South Asia 44.8 35.0 22.8 12.4 y,z 29.0 z 44.3 0.3 2.0 722 –

East Asia and Pacific 15.8 9.0 9.7 10.0 y,z** 5.7 21.2 0.1 1.4 897 –Latin America and Caribbean 17.7 9.6 9.9 10.5 10.9 74.3 1.5 11.4 808 –

CEE/CIS‡ 13.1 8.5 6.7 5.4 y,z 7.3 29.0 0.9 1.0 908 –

World 39.1 22.2 17.6 12.6 y,z** 16.0 50.4 0.9 z 3.3 781 –


18 Save the Children. Progress in Child Well-Being: Building on What Works. (London: 2012)

19 Ozawa, Sachiko, et al. “Return on Investment From Childhood Immunization in Low- and Middle-Income Countries, 2011–20.” Health Affairs. Vol. 35, No. 2. February 2016

20 See, for example: Chaaban, Jad and Wendy Cunningham. Measuring the Economic Gains of Investing in Girls: The Girl Effect Dividend. (World Bank: 2011) and Mercy Tembon and Lucia Fort. Girls’ Education in the 21st Century: Gender Equality, Empowerment,and Economic Growth (World Bank: 2008)

21 See, for example: UNICEF, www.unicef.org/earlychildhood/index_69851.html

22 Gavi, the Vaccine Alliance. Vaccine Support. www.gavi.org/support/nvs/

23 See also: ODI and Save the Children. Progress in Child Well-Being: Building on What Works. (London: 2012)

24 See, for example: Chaaban, Jad and Wendy Cunningham. Measuring the Economic Gains of Investing in Girls: The Girl Effect Dividend. (World Bank: 2011); Mercy Tembon and Lucia Fort. Girls’ Education in the 21st Century: Gender Equality, Empowerment, and Economic Growth and OECD. Gender Equality in Education, Employment and Entrepreneurship: Final Report to the MCM 2012. (Paris: 2012)

25 Sustainable Development Goals. Gender Equality: Why it Matters. (2018)

26 Ibid.

27 UN Women. Turning Promises into Action: Gender Equality in the 2030 Agenda for Sustainable Development. (New York: 2018)

28 Inter-Parliamentary Union. Women in National Parliaments. archive.ipu.org/wmn-e/world.htm. Accessed 12 March 2019

29 Inter-Parliamentary Union Open Data. data.ipu.org. Accessed 12 March 2019

30 Inter-Parliamentary Union. Women in National Parliaments. archive.ipu.org/wmn-e/classif.htm. Accessed 12 March 2019

31 See, for example: UN Women. In Brief: Women’s Leadership and Political Participation; Inter-Parliamentary Union. Equality in Politics: A Survey of Men and Women in Parliaments (2008); Klugman, et al. Voice and Agency: Empowering Women and Girls for Shared Prosperity. (World Bank: 2014); UNDAW. Equal Participation of Women and Men in Decision-Making Processes, with Particular Emphasis on Political Participation and Leadership, Report of the Expert Group Meeting Addis-Ababa, Ethiopia 24-27 October 2005; Susan Markham. “Women as Agents of Change: Having Voice in Society and Influencing Policy.” Women’s Voice, Agency, and Participation Research Paper 5. (World Bank: 2013)

32 One study, for example, found that as the percentage of women in parliament increases by 5%, a nation is 5 times less likely to use violence when faced with an international crisis. Another showed that when at least 35% of the legislature is female, the likelihood of a state relapsing into civil war is virtually zero. Including women in peace processes makes them 64% less likely to fail and 35% more likely to last at least 15 years. For more, see: Our Secure Future. The Evidence for Women, Peace and Security. (2018)

33 Hicks, et al. “Women as Policy Makers and Donors: Female Legislators and Foreign Aid.” European Journal of Political Economy, Volume 41, 2016

34 Girls Not Brides. 16 Activists Who Tackle Child Marriage Every Day. www.girlsnotbrides.org/16-activists-who-tackle-child-marriage-every-day/

35 International Telecommunication Union (ITU). Measuring the Information Society Report. (2018)

36 Global e-Sustainability Initiative. Enabling the Global Goals: Evidence of Digital Solutions’ Impact on Achieving the Sustainable Development Goals. (2018)

37 World Bank. World Development Report 2016: Digital Dividends. (2016)

38 UNICEF. Children, ICT and Development: Capturing the Potential, Meeting the Challenges. (Florence: UNICEF Office of Research: 2013)

39 WHO. eHealth and Innovation in Women’s and Children’s Health: A Baseline Review. (Geneva: 2014)

40 ITU. Fast-Forward Progress: Leveraging Tech to Achieve the Global Goals. (Geneva: 2017)

41 Kenny, Charles. “Getting Better in Pictures.” Center for Global Development. February 2011

1 These figures represent the difference between the total number of children affected by each childhood ender in 2000 and the total number affected at last estimate. The most recent year for which these global estimates are available is 2018 for stunting, 2017 for under-5 mortality, children out of school and child marriage, and 2016 for child labor, adolescent births and child homicide.

2 One-fifth of these children have died. The rest – 545 million or 24 percent of children under the age of 18 worldwide – are alive and missing out on childhood. For details on this analysis, see the Methodology and Research Notes.

3 Queen’s University Belfast and Save the Children. Enabling the Exercise of Civil and Political Rights: The Views of Children. (2016)

4 The Convention on the Rights of the Child (CRC) represents a global consensus on the terms of childhood. It recognizes childhood as a separate space from adulthood defined by a specific set of rights. It is the responsibility of all duty bearers for children – governments, international organizations, civil society, families and individuals – to ensure that children’s rights are fulfilled and protected. When children are left unprotected and vulnerable to exploitation and abuse, their childhood is undermined. A protective environment is pivotal to governments’ and societies’ commitment to ensuring that no child is deprived of the material, spiritual and emotional resources needed to achieve their potential or participate as full and equal members of society. This report shows that for hundreds of millions of children, the promise of childhood that undergirds the Convention is a broken one. For more on the CRC’s role in defining the concept of childhood, see UNICEF’s State of the World’s Children 2005.

5 This set of countries refers to those included on the World Bank Group’s Harmonized List of Fragile Situations from FY06 to FY19. The full list with details can be found at worldbank.org/en/topic/fragilityconflictviolence/brief/harmonized-list-of-fragile-situations

6 McArthur, J.W. and K. Rasmussen. “Change of Pace: Accelerations and Advances during the Millennium Development Goal Era.” World Development 105 (2018) 132–143

7 The same Brookings study found that for undernourishment and access to safe water, accelerations in the majority of developing countries were outweighed by slowdowns in the rate of progress in many populous countries (i.e., more people were undernourished and without water in 2015 than would have been had 1990s trends continued).

8 The World Bank. “Ending Extreme Poverty Hinges on Progress in Fragile and Conflict-affected Situations.” 30 April 2013; UN ESCAP. “Make the Voices Heard of the 1.5 Billion People in Fragile & Conflict-Affected Areas.” 27 February 2013

9 See, for example: Understanding Children’s Work Programme. Understanding Trends in Child Labour: A Joint ILO-UNICEF-The World Bank Report. (Rome: 2017); Girls Not Brides. Lessons Learned from Selected National Initiatives to End Child Marriage - 2016. (London: 2017) and Overseas Development Institute and Save the Children. Progress in Child Well-Being: Building on What Works. (London: 2012)

10 See, for example: General Economics Division (GED), Planning Commission, Government of the People’s Republic of Bangladesh; UNDP. Briefing Note for Countries on the 2018 Statistical Update - Colombia. (2018) and National Planning Commission and the United Nations in Ethiopia. MDG Report 2014 Ethiopia (2015)

11 Understanding Children’s Work Programme. Understanding Trends in Child Labour: A Joint ILO-UNICEF-The World Bank Report. (Rome: 2017)

12 Overseas Development Institute (ODI) and Save the Children. Progress in Child Well-Being: Building on What Works. (London: 2012)

13 Buchmann, Nina, et al. Power vs Money: Alternative Approaches to Reducing Child Marriage in Bangladesh, a Randomized Control Trial. (2017)

14 Mehrotra, S. (2004) Improving Child Well-being in Developing Countries: What do we know? What can be done?, Report 9, London: CHIP

15 ODI and Save the Children. Progress in Child Well-Being: Building on What Works. (London: 2012)

16 Save the Children. A Fair Chance at Life: Why Equity Matters for Child Mortality. (London: 2010) and UNICEF. Narrowing the Gaps to Meet the Goals. (New York: 2010)

17 OECD. Official Development Assistance 2017 - Preliminary Data. www2.compareyourcountry.org/oda?cr=20001&cr1=oecd&lg=en&page=1. Accessed 11 March 2019

Endnotes


42 Pew Research Center. Social Media Use Continues to Rise in Developing Countries, but Plateaus Across Developed Ones. June 2018

43 World Economic Forum. Global Agenda Council on Social Media 2012-2014. www3.weforum.org/docs/GAC/2013/WEF_GAC_SocialMedia_MidtermReport.pdf

44 World Bank. The Role of Social Media in Development. blogs.worldbank.org/publicsphere/role-social-media-development

45 UNICEF. The State of the World’s Children 2017: Children in a Digital World. (New York: 2017)

46 See, for example: Ackland, Robert and Kyosuke Tanaka. “Development Impact of Social Media.” Background paper for the World Development Report 2016. (2015); WHO. Global Diffusion of eHealth: Making Universal Health Coverage Achievable. Report of the Third Global Survey on eHealth. (Geneva: 2016); USAID. Social Networking: A Guide to Strengthening Civil Society Through Social Media (2016) and One Earth Future. Women Using Media to Mobilize for Peace.

47 Girls Not Brides. It Takes a Movement: Reflecting on Five Years of Progress Towards Ending Child Marriage. (2016)

48 YaleGlobal Online. Can Social Media Campaigns End Child Labor?

49 Pew Research Center. Stories from Experts about the Impact of Digital Life. July 2018

50 Pew Research Center. The Future of Well-Being in a Tech-Saturated World. April 2018

51 The Borgen Project. U.S. Benefits from Foreign Aid to Niger. https://borgenproject.org/u-s-benefits-from-foreign-aid-to-niger-2/

52 Niger Ministry of Finances. http://www.finances.gouv.ne/



ACKNOWLEDGEMENTSThis report was written and project-managed by Tracy Geoghegan from Save the Children. The researchers were Beryl Levinger and Nikki Gillette.

Production of this report would not have been possible without valuable inputs and feedback from many colleagues across the global Save the Children movement. We are grateful for the contributions of: Simine Alam, Nahashon Aluoka, Kitty Arie, Mariam Atahi, Smita Baruah, Jeniffer Campos, Wendy Christian, Daphnee Cook, Carol da Silva, Eric Eversmann, Azucena Garcia, Kimberley Gardiner, Davina Hagan, Sharon Hauser, Eric Hazard, Ramatu Jalloh, Negin Janati, Joan Jennings, Madhu Kalra, Laila Khondkar, Michael Klosson, Mónica Kuljich, Kristen Lacey, Ana Lagidze, Claire Leigh, Jessica Lenz, Laurel MacLaren, Caitlin Macquarrie, Ishtiaq Mannan, Tracy Manners, Carolyn Miles, Elizabeth Muiruri, Grace Nyoro, Shannon Orcutt, Sierra Mae Paraan, Silvia Paruzzolo, Ivonne Piedras, Jennifer Roberti, Bernice Romero, Hagar Russ, Sean Ryan, Rukayah Sarumi, Sokpheap Say, Vishna Shah, Callie Simon, Alison Sutton, Eric Swedberg, Devendra Singh Tak, Patrick Watt, Simon Wright, Victoria Zegler, Lucia Zoro and many others around the world.

We especially want to thank colleagues who contributed case studies for this report who are based in Afghanistan, Bangladesh, Colombia, Ethiopia, India, Mexico and Philippines.

A special thank you to Angelica Cadavid for her many contributions to report content and project management. Thanks also to Charlotte Green, Gabriel Smith and Kirsten Walkom for global coordination and project management. Thank you to Judy Cusick, Lois Jensen and Mike Kiernan for editorial support. And to Joe Ansah, Senad Ibrahimbegovic and Maribel Paredes for their work on design and production.

Design by Alison Wilkes.

GLOBAL CHILDHOOD REPORT 29Photo: Save the Children Mexico

These Mexican girls enjoy music and dance activities that build their reading skills.

Published by Save the Children

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ISBN: 1-888393-36-X

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ON THE COVERDjeneba, age 11, is a student in sixth grade at Kassanso School in Mali.

Photo: Talitha Brauer / Save the Children

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